Under Dr. Farzad Mostashari's leadership, Office of National Coordinator staffers described the federal role as one of acting where the private sector does not. With only a few notable exceptions, the ONC, as led by Mostashari and his predecessor, Dr. David Blumenthal, tended to exercise those regulatory levers freely. The HITECH Act gives HHS and the ONC the authority to not only define the three stages of meaningful use freely, but to extend it and related EHR certification requirements into the foreseeable future, in areas where it is perceived that a potential public good can be accomplished.
It is exciting to recall and celebrate the tremendous progress that's been achieved in unleashing IT on the nation's healthcare challenges. Visionaries touted the potential of electronic records to improve the quality of healthcare for several years before President George W. Bush named Dr. David Brailer to be the first national IT coordinator in 2004. Brailer outlined a simple but elegant four-pronged plan—inform clinical practice, interconnect clinicians, personalize care and improve population health.
Brailer's evangelism, supported by a bare-bones budget, worked in convincing providers, vendors and politicians that the time had come for the EHR. My organization hosted one of his early town hall meetings in late 2004. His passion and persuasion sold many of the attendees who, until then, had straddled the fence on their commitment. While Brailer was not a strong advocate for public funding of the EHR, we will never know the intensity of regulation that his ONC would have brought with federal money.
DeSalvo's appointment has been widely praised by the industry. Her accomplishments in New Orleans have been notable for the relatively short time that she was in office. With DeSalvo's public health background (similar to that of Mostashari), many expect her to focus on community-centered medicine. The ONC Town Hall meeting in late January will be an excellent launch and opportunity to rally the ONC team and the public.
As DeSalvo begins the serious business of leading healthcare IT policy, we can only speculate on the balance she will seek among change through innovation and persuasion, and change through regulation. That will make industry public policy work of greater importance.
Providers already have received most of the incentive dollars available through the HITECH Act. In future years, it will be able to only look forward to the significant costs to comply with future regulations, or to payment reductions for not having met meaningful-use requirements. Among immediate examples of regulatory oversight are the harmonization of performance indicators across value-based purchasing programs and meaningful use, adoption of electronically captured indicators and the many aspects of patient engagement, to mention only a few.
With HHS and ONC having seemingly unobstructed authority to establish further requirements for EHRs to achieve, the public policy role of CHIME and other trade associations becomes institutionalized, as it must. Our long-term success will be ensured as our organizations view IT-related policy matters in the same light as payment reform and other critical topics. We must arm other senior leaders and government relations specialists with important IT messages as they work with their government contacts. At that point, health IT will have fully arrived in the public policy arena.
Bill SpoonerSenior vice president and CIOSharp HealthCareSan Diego